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Camp Application Form

For your convenience, we offer this online camp application form to enroll a child for our free summer camp program. Please fill out the form as completely as possible and make sure you check the box that confirms that you will abide by the waivers and conditions of camp enrollment.

  1. 2017 Application
  2. (required)
  3. Gender
  4. (required)
  5. (required)
  6. (required)
  7. (required)
  8. (required)
  9. (required)
  10. (required)
  11. (required)
  12. IN CASE OF ACCIDENT OF ILLNESS the primary caregiver will be notified first. Please list two other people who can be contacted:
  13. (required)
  14. (required)
  15. Does child need a ride from the central pickup in Kansas City?
  16. Does child have any physical handicaps we should know about?
  17. Does your child have any allergies that will bother him/her at camp?
  18. (required)
  19. (required)
  20. (required)
  21. Do we have permission to distribute Children's Tylenol to your child for minor headaches or other minor aches and pains?
  22. Camp Sessions are filled on a first come, first serve basis. You will receive a confirmation notice once your child is confirmed to attend a camp session.
  23. Please select each session listed below that your child is AVAILABLE to come to camp according to age and gender
  24. WAIVERS AND CONDITIONS: Pictures taken at camp may be used for advertisement purposes. (Examples: brochures, support newsletters, web pages, etc.) Camp Del-Haven is released from any liability in the event of an illness or accident that may occur to any camper. Each camper must be insured by their own provider. By submitting your name and checking the "I Agree" box, the Parent/Guardian gives Camp Del-Haven the right to arrange for any special services or medical attention necessary for the camper's welfare and good health. The parent/guardians are responsible for any expenses that may result from such services.
  25. I affirm that the information given is correct and accurate. I have carefully read the waivers and conditions of enrollment and agree to abide by them:
  26. (required)
  27. (required)
  28. FOR ANTI-SPAM VERIFICATION, PLEASE ANSWER THE QUESTION BELOW IN LOWER CASE:
 

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Directions

From I-70 or 50 Highway, take Route F Highway, then turn east onto Cline Road. Turn right at Lake Paradise and continue down the gravel road until you reach the entrance to Camp Del-Haven. We are approximately 30 miles east-southeast of Kansas City, MO.

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887 NW 1901
Lone Jack, MO 64070
(816) 690-8465